Management of Cubital Tunnel Syndrome in Split-Hand/Split-Foot Malformation: A Case Report and Review of Ulnar Nerve Dependence in Cleft Hand Prehension.

INTRODUCTION: Split-hand/split-foot malformation (SHFM) is a congenital limb defect characterized by central ray deficiency, resulting in deep median clefts of the hands and/or feet. Due to the nature of the malformation, the outer digits - those predominantly innervated by the ulnar nerve - are typically spared. In patients who rely on central cleft adduction and abduction as a substitute for thumb-index opposition, the ulnar nerve may assume a disproportionately critical role in hand function.

CASE REPORT: We report a case of bilateral cubital tunnel syndrome (CubTS) in a 23-year-old patient with familial SHFM. We review the variable phenotypes of SHFM, the Manske and Halikis classification system, the clinical presentation and management of CubTS, and the functional anatomy of cleft closure.

CONCLUSION: We argue that the prioritization of neuropathy treatment in patients with congenital hand malformations should be advanced, given their overreliance on different nerve-distributed musculature for essential hand function.